[Federal Register Volume 62, Number 75 (Friday, April 18, 1997)]
[Notices]
[Pages 19154-19155]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 97-10085]


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SOCIAL SECURITY ADMINISTRATION


Agency Information Collection Activities: Proposed Collection 
Requests

    This notice lists information collection packages that will require 
submission to the Office of Management and Budget (OMB), in compliance 
with Public Law 104-13 effective October 1, 1995, The Paperwork 
Reduction Act of 1995.
    1. Consent for Release of Information--0960-0567. The information 
collected on form SSA-3288 is used by the Social Security 
Administration (SSA) to ensure that an individual consents to the 
release of his/her personal information to another individual. The 
respondents are individuals assenting to the disclosure of information 
from their social security records to someone else.
    Number of Respondents: 200,000.
    Frequency of response: 1.
    Average Burden Per Response: 3 minutes.
    Estimated Annual Burden: 10,000 hours.
    2. Application for Special Age 72-or-Over Monthly Payments--0960-
0096. The information collected on form SSA-19 is used by SSA to 
determine entitlement of individuals to special age 72-or-over 
payments. The respondents are applicants who file for the special 
payment.
    Number of Respondents: 15.
    Frequency of Response: 1.
    Average Burden Per Response: 20 minutes.
    Estimated Average Burden: 5 hours.
    3. Request for Self-Employment Information (SSA-2765), Request for 
Employment Information (SSA-3365), Request for Employer Information 
(SSA-4002)--0960-0508. The information is needed by SSA when earnings 
information reported to the agency is incomplete or incorrect. The 
information is used to post the reported earnings to the appropriate 
earnings record. The respondents are employers of the wage earners or 
employees and self-employed individuals for whom the earnings were 
reported.
    Number of Respondents: 3,000,000.
    Frequency of Response: 1.
    Average Burden Per Response: 10 minutes.
    Estimated Annual Burden: 500,000 hours.
    4. State Agency Report of Obligations for SSA Disability Program--
0960-0421. The information collected on form SSA-4513 is used by SSA in 
a detailed analysis and evaluation of costs incurred by the State 
Disability Determination Services (DDS) in making determinations of 
disability for SSA and to determine funding levels for each DDS. The 
respondents are State DDS offices.
    Number of Respondents: 54.
    Frequency of Response: 4.
    Average Burden Per Response: 1 hour.
    Estimated Annual Burden: 216 hours.
    5. State Vocational Rehabilitation Agency Claim (SSA-199) and 
Subpart V--Payments for Vocational Rehabilitation Services, 20 CFR 
Sections 404.2104, 404.2108, 404.2113, 404.2117, 404.2121, 416.2204, 
416.2208, 416.2213 and 416.2217--0960-0310. The information collected 
on form SSA-199 and through this current rule is used by the Social 
Security Administration to determine if State vocational rehabilitation 
agencies are providing appropriate services, including referrals when 
necessary, and whether those claims for services should be paid.
    Number of Respondents: 80-100.
    Frequency of Response: On occasion.
    Average Burden Per Response: Varies from 23 minutes to 4 hours.
    Estimated Annual Burden: 8,465 hours.
    Written comments and recommendations regarding the information 
collection(s) should be sent within 60 days from the date of this 
publication, directly to the SSA Reports Clearance Officer at the 
following address: Social Security Administration, DCFAM, Attn: Judith 
T. Hasche, 6401 Security Blvd., 1-A-21 Operations Bldg., Baltimore, MD 
21235.
    In addition to your comments on the accuracy of the agency's burden

[[Page 19155]]

estimate, we are soliciting comments on the need for the information; 
its practical utility; ways to enhance its quality, utility and 
clarity; and on ways to minimize burden on respondents, including the 
use of automated collection techniques or other forms of information 
technology.
    To receive a copy of any of the forms or clearance packages, call 
the SSA Reports Clearance Officer on (410) 965-4123 or write to her at 
the address listed above.

    Dated: April 11, 1997.
Frederick W. Brickenkamp,
Forms Management Officer, Social Security Administration.
[FR Doc. 97-10085 Filed 4-17-97; 8:45 am]
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